不同麻醉药物配伍对高龄危重患者血压、心率的影响

Influence of different combination of anesthetics on BP and HR during operation in aged patients with serious illness

目的探讨不同麻醉药物组合对高龄危重患者麻醉诱导及术中血压(BP)、心率(HR)的影响。方法40例80岁以上ASAⅡ-Ⅲ级老年择期手术患者,随机分为A、B两组(每组20例),A组麻醉诱导及维持采用咪唑安定+芬太尼+异氟醚;B组麻醉诱导及维持采用依托咪酯+七氟醚+氧化亚氮-氧气混合气。观察两组患者麻醉诱导前(T0)、诱导后(T1)、插管时(T2)、切皮时(T3)、切皮后30min(T4)、术毕拔管时(T5)的平均动脉压(MAP)、HR以及脑电双频谱指数(BIS)的变化。结果A组患者诱导后BIS由95±2降为52±4,MAP、HR由110±11mmHg、73±8/min分别降至75±9mmHg、59±4/min;B组患者吸入诱导后BIS值由94±3降至58±3,其MAP、HR分别由103±8mmHg、76±6/min降至87±7mmHg、67±5/min。气管插管时,两组间BIS无差异,而A组MAP、HR较B组明显升高(P<0.01或P<0.05)。结论高龄危重患者手术中应用依托咪酯+七氟醚+氧化亚氮诱导及术中麻醉能维持其BP、HR较为稳定。

Objective To evaluate the influence of different combination of anesthetics on blood pressure （BP） and heart rate （HR） of aged patients with serious illness during operation. Methods Forty patients, aged 80492, with physical status Ⅱ-Ⅲ as categorized according to American Society of Anesthesiologists （ASA） undergoing selective surgery, were randomly divided equally into two groups： in group A ancsthesia was induced with midazolam, fentanyl and maintained with isoflurane, and in group B anesthesia was induced and maintained with etomidate, sevoflurane and nitrous oxide. Mean arterial pressure （MAP）, HR and bispectral index （BIS） were observed at the points of preinduction （To）, induction （T1）, intubation （T2）, incision （T3）, 30 minutes after incision （T1） and extubation （T5）. Results After induction, BIS decreased from 95±2 to 52±4, while MAP and HR decreased from 110±11mmHg and 73±8/min to 75±9mmHg and 59±4/min respectively, in group A. While in group B BIS decreased from 94±3 to 58±3, MAP and HR decreased from 103±8 mmHg and 76±6/min to 87±7 mmHg and 67±5/min, respectively. At the point of tracheal intubation, MAP and HR increased significantly in group A compared with group B （ P〈0. 01 or P〈0. 057. Conclusion The hemodynamics is more stable in aged patients with serious illness when etomidate, sevoflurane and nitrous oxide are used during operation.